Aaron Carroll twits conservatives this morning for reversing course on the subject of deductibles:
The revelation that many plans in the Patient Protection and Affordable Care Act‘s health insurance exchanges have high deductibles has put many of the law’s conservative opponents into a corner: Once in favor of high deductibles, these critics of ObamaCare are suddenly worried about the risk to consumers…
But as readers of the previous post now know, I actually don’t favor high deductibles. There are far better ways of combining HSAs and third party health insurance. But Carroll brings up a point that I didn’t discuss that deserves mention. He writes:
There’s plenty of good evidence that increased cost-sharing such as that seen in high-deductible health plans can lead to negative consequences for some patients. My own experience as a physician backs that up. I often find that patients have a difficult time getting the care they need…Trying to reduce it with increased cost-sharing might actually do harm.
Here’s the problem. People are not very good at saving for medical contingencies on their own. As a consequence, they may inappropriately forego needed care because of a cash flow problem. Enter the Health Savings Account. I have always regarded HSAs as a paternalistic idea. If you like, they are a “nudge” idea. The money the employer puts in the account is the employees’ money. After a period of time they can withdraw it for other uses.
Its only role is to insure that when people make choices between health care and other uses of money these choices are based on relative values, not on the constraints of cash flow.
One more point made by Greg Scandlen the other day: It is foolish to choose a low deductible plan if the extra premium you must pay is more than the reduction in the deductible. In that case you would be paying more than a dollar for a dollar’s worth of insurance. That’s wasteful in anyone’s book.